There’s no easy way to quit smoking. Studies report that the nicotine patch doesn’t work without regular medical assistance, nicotine gums are ineffective, and chemical assistance comes with a list of terrible side effects. Vaping, e-cigarettes and other devices, were thought to be the best smoking cessation options out there, because they involved fewer harmful chemicals per puff and more options to gradual cessation.
Now that’s in jeopardy, as vapes have been linked to more than 450 possible cases of severe lung disease in 33 states, now with three confirmed deaths and one more under investigation. A patient in Oregon used their e-cigarette to vape cannabis. It doesn’t necessarily mean they’re connected, but it has definitely attracted widespread interest from regulators and scientists alike.
“We don’t yet know the exact cause of these illnesses — whether they’re caused by contaminants, ingredients in the liquid or something else, such as the device itself,” said Ann Thomas, M.D., public health physician at OHA’s Public Health Division.
E-liquid is the industry nomenclature for the amber oil contained in e-cigarette cartridges. Its manufacturing process involves extracting nicotine from tobacco with a base (usually propylene glycol). It comes in different flavours, colours and other chemicals—including the smoker’s time honoured favourite—formaldehyde, but also the unsaturated aldehyde, acrolein. Both of these cause irreversible lung damage.
Both the FDA and Health Canada consider propylene glycol and vegetable glycerin safe as food additives, but that doesn’t extend to ingesting them through the lungs. In cigarettes, tobacco is burned and the smoke inhaled, but e-cigarettes involve the two solvents taking the place of tobacco smoke.
It’s the popylene glycol, and the possibility of vitamin E ingestion that’s caused the FDA and Health Canada to issue the following warning:
Patients using vape products reported a variety of symptoms, developing over a period of days to weeks, including:
- Pulmonary symptoms (cough, shortness of breath, chest pain)
- Gastrointestinal symptoms (nausea, vomiting, diarrhea)
- Fatigue
- Fever
- Headache
- Weight loss
Vitamin E Acetate
Previously doctors had reported cases of lung injury closely associated with the use of e-cigarettes, including ‘lipoid penumonia.’ Lipoid pneumonia is when fat deposits build up in the lungs over a matter of months.
The Government of New York performed laboratory tests and uncovered vitamin E acetate as a common component in nearly all the cannabis-containing samples.
“Vitamin E acetate is basically grease,” said Michelle Francl, a chemistry professor at Bryn Mawr College.
“Its molecular structure means that “you have to heat it up pretty hot” for it to vaporize. Its boiling point is 363 degrees Fahrenheit, which is well above the 212 degrees F boiling point for water. Once the oil is heated hot enough to vaporize, it can potentially decompose, and “now you’re breathing in who-knows-what. When that vapor cools down in the lungs, it returns to its original state at that temperature and pressure.”
The remainder is left as a coating in the lungs.
Dr. Nora D. Volkow, Director of the National Institute on Drug Abuse, went to Twitter with a concise summary of the problem:
“There is no oversight…No one is actually evaluating the products to see whether they are pure, or if they contain toxic substances. There has to be some way of regulating them.” #vaping #ecigs #kidshealth #juulisoverhttps://t.co/TfiwvtERwB
— NC Child (@ncchild) September 3, 2019
Canada hasn’t had any reported cases yet, but Dr. Andrew Pipe, who assisted in the development of the Ottawa smoking cessation model at the University of Ottawa Health Institute, thinks that doesn’t mean it isn’t happening.
We may see more cases emerge as awareness about the links between vaping and lung disease grows, because of the research happening south of the border.
—Joseph Morton